Clinical and angiographic characteristics of cavernous sinus dural arteriovenous fistulas manifesting as venous infarction and/or intracranial hemorrhage.
BACKGROUND
Cavernous sinus (CS) dural arteriovenous fistulas (DAVFs) rarely cause venous infarction (VI) and/or intracranial hemorrhage (ICH) despite the presence of cortical venous drainage (CVD). The present study investigated the characteristics of CS DAVFs manifesting as VI/ICH.


METHODS
Fifty-four patients treated for CS DAVFs were retrospectively studied.


RESULTS
Six patients presented with VI/ICH. Two of the three patients presenting with ICH had CVD only to the superficial sylvian vein (SSV) or the deep sylvian vein (DSV). Three patients presenting with VI had multiple drainages, and angiography of these patients showed a varix on the SSV, drainage into the DSV with agenesis of the second and third segment of basal vein of Rosenthal, and thrombosis of the distal petrosal vein. CS DAVF with CVD only carries higher risk of VI/ICH than multiple drainages. Many CS DAVFs presenting with VI, especially those with drainage into the petrosal vein, have multiple drainages in the early stage. Thrombosis of the inferior and superior petrosal sinuses and superior orbital vein gradually increases pressure of the CVD, and then, VI may occur. In contrast, CS DAVFs with CVD only from the beginning, common in the patients with drainage into the SSVs and DSVs, are likely to cause ICH.


CONCLUSIONS
Angiographic risk factors causing VI/ICH are CVD only, varix formation, agenesis of the second and third segment of basal vein of Rosenthal, and thrombosis of the superior orbital vein, lateral half of the superior petrosal sinus, and distal CVD.
Miyamoto
Naoko
N
Department of Neurosurgery, Geriatrics Research Institute and Hospital, 3-26-8 Ootomo-cho, Maebashi, 371-0847, Japan. naochop96201088@w9.dion.ne.jp
Naito
Isao
I
Takatama
Shin
S
Shimizu
Tatsuya
T
Iwai
Tomoyuki
T
Shimaguchi
Hidetoshi
H
D000368:Aged; D001164:Arteriovenous Fistula / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D001921:Brain / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology; D020520:Brain Infarction / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D002426:Cavernous Sinus / Q000002:abnormalities* / Q000473:pathology; D020785:Central Nervous System Vascular Malformations / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D002533:Cerebral Angiography; D002550:Cerebral Veins / Q000473:pathology; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed